‎"One of my patients had severe post-traumatic stress disorder. His experience of isolation and helplessness sent shockwaves through his day-to-day life. He had flashbacks and significant difficulty relating to others.

We began his treatment with daily pranayama. We added meditation on both the destructive and creative aspects of the mother goddess Kali. Finally, he began to meditate on his own eternal nature: “I am that I am” (Hum So). Slowly but surely, this healed his illness..."

I worked with a private student today and after 10 years of teaching I am still amazed at how transformative the breath is. She is a relative newbie to yoga and in her classes at various venues from health clubs to studios, teachers have told her to "focus on the breath" but apparently no one has ever TAUGHT her how.

I could see how tight her belly and shoulders were. We did conscious breathwork just like Mark Whitwell or Ramaswami or my teachers at the Krishnamacharya Yoga Mandiram teach. A light bulb went off over her head. Her entire body visibly relaxed and she left my house looking lighter and brighter. In a word, transformed.

She's returning for more instruction on the breath and wants to work with me in the vinyasa krama method:

“By integrating the functions of mind, body, and breath...a practitioner will experience the real joy of yoga practice. . .Vinyasa krama yoga strictly follows the most complete definition of classical yoga.” – Srivatsa Ramaswami, The Complete Book of Vinyasa Yoga

01 July 2011

"Breath is a reminder of trauma. Sensory messages from muscle and connective tissue that remember a specific position, action, or intention can be sources of triggers. Accelerated heart rate and increased respiration can be implicit reminders of that same reaction that accompanied the trauma."

As we talked about the breath during the training, I thought about how fortunate I am to have studied directly in the Krishnamacharya lineage -- studying with Srivatsa Ramaswami, Desikachar, Mark Whitwell, and lately with Gary Kraftsow. They all studied with Krishnamacharya and Krishnamacharya's yoga is all about linking breath with movement. This aspect is crucial in teaching trauma sensitive yoga.

Donna Farhi has said that "breath is a dynamic system that most of the time runs on automatic, allowing input from internal organs to mange the rate and depth of breathing."

Trauma is stored in the body and body memories can override thinking. Breath is the doorway to the nervous system -- trauma survivors have layers of physiological defenses in place that serve as psychological infrastructure and protection from implicit memories. Removing these defenses too quickly can result in significant destablization.

Hearing this I thought about the yoga classes I've taken where pranayama is indiscriminately taught, seemingly for no purpose other than to fill space in the class (this is my experience, your mileage may vary.) I became more aware of this after I returned from studying at the Krishnamacharya Yoga Mandiram the first time.

In that lineage yoga practice is asana-pranayama-meditation. I remember being in a class after my return and the first thing the teacher did was kapalabhati breathing -- no explanation, no instruction, just do it. It was very jarring (I started but did not finish) and I thought...HUH? Does this teacher know everyone's dosha in the first place to be doing this? If it did not feel at all right to my system, an experienced practitioner, I could only imagine what it felt like to the ones who were brand new to yoga in this class.

If you've read the first two parts of this series, you'll know where I am going with this. Breathing -- just doing it or hearing the breath of another student -- can be a PTSD trigger for trauma survivors. Ujayi breath can be very scary; techniques such as kapalabhati and breath retention are out of the question in a trauma sensitive yoga class.

Trauma sensitive breathing should always be performed in the context of a muscular, physical form (asana) to facilitate grounding and present moment experience. The movements are always initiated by the inhale or the exhale, because breath alone can trigger PTSD.

What are some breath practices for a trauma sensitive yoga class? Simple breath awareness (constant attention to the breath); "add a little" breath; emphasizing breathing through the nose because some trauma survivors breath through their mouths; nadi shodana; and ratio breathing, i.e., different counts for the inhale/exhale.

The bottom line is helping people notice when their breath changes, helping them notice the quality of their breath so they can notice their experience in the present moment. Mindfulness. Just this, just here, just now.

As you may have determined, with so many PTSD triggers, being trauma sensitive in a "regular" group yoga class would prove difficult. Although a trauma survivor may really want to experience yoga, the thought of walking into a public yoga class might be too challenging, too scary. In his book Overcoming Trauma Through Yoga, our teacher Dave Emerson wrote about the experiences of trauma survivors in public yoga classes. One woman said that just the experience of a teacher walking up to her slowly and silently as the woman was in child's pose was enough to make her run out and never return. She did not feel safe at all.

Creating a yoga class exclusively for PTSD or trauma survivors creates community, a sangha. We were advised not to do this work in a vacuum, but to connect with a mental health professional, a VA center, a domestic violence shelter, among others. We were also advised not to work privately with students because of safety issues. I feel confident enough to work privately with domestic violence and sexual assault survivors, but I might not feel secure with others, it would depend on the situation. I am using The Trauma Center's protocols in working one-on-one with TS students: (1) the student must also be working with a psychologist, psychiatrist, or other mental health professional so we can work together as a team; (2) the student must continue taking their medication, if any; (3) the student must not have been hospitalized for any psychological issues within the last six months; (4) there can be no active psychosis.

At the start of our training, the question was raised: how must yoga in America change if 80% (according to a collection of research) of the population have experienced or witnessed trauma? Trauma is defined by Dr. van der Kolk as being inescapable stress, heightened alertness (constant hyperarousal), or helplessness in response to an event. Some responses to these states are detachment/disconnection from the body, self, or social relationships; insomnia; fight or flight responses; depression; chronic pain; constant intrusive thoughts; consistent feelings of anger and shame; substance abuse.

We were asked: do we need to return to a "simpler way" of yoga?

This training was one of the most influential trainings I've taken in my 10 years of teaching. I hope I have helped both yoga teachers and trauma survivors in this three part series.

Krishnamacharya said that breath is central to yoga because it is central to life...and yoga is about life. Trauma is a part of life, but we do not have to allow it to define us. Yoga is about replacing old negative patterns with new positive ones, one step at a time.

"Congratulations on a very creative, positive, and authentic blog that represents the true spirit of the yoga journey, inner and outer. You have a vivid, natural voice and a passionate knowledge of your subject, which should carry you a long way if you choose to direct your energies toward print publication." (Anne Cushman, author of Enlightenment for Idiots)